Sunday, October 28, 2012

Continuing neglect of mental health dangerous

By Lukoye Atwoli
Sunday Nation 21 October 2012

Just under two weeks ago, the world marked the World
Mental Health Day. In Kenya, it was in a low-key manner unlike in the
past when there would be processions and speeches at a public health
facility, and usually around the Mathari Hospital in Nairobi.

Perhaps
the low-key commemoration was an appropriate metaphor for the amount of
attention being paid to this very important aspect of our national
life. Despite going through the annual ritual of lamenting under
funding for mental health and neglect of the national referral mental
hospital, very little seems to change each year.

Indeed, it could
be argued that things are getting worse. Predictably, rates of mental
illness are increasing as a function of industrialisation and
“development”. Further, as people become more and more aware of mental
health issues, demand for mental health services continues to rise.

Finally,
as the national population continues growing rapidly, the absolute
numbers of people with mental illness will follow suit, even if the
prevalence rates remain constant. The upshot of this increased demand is that we need more mental health facilities and workers to address this need.

Unfortunately,
the health sector as a whole is suffering from systemic neglect born of
government policy that considers health to be a side-issue that can be
addressed after “more important” sectors have been taken care of. Despite
government commitment to spend 15 per cent of the budget on health,
current expenditure is still less than half that figure.

Health
facilities are still largely understaffed, have old and battered
equipment, and suffer from shortages of essential supplies. To
make matters worse, less than one per cent of the health budget is spent
on mental health, with the bulk of it going to pay salaries. The
Kenya Board of Mental Health, established by statute over two decades
ago, has yet to be facilitated and its effect has not been felt across
the land. Regional mental health boards as provided for in the same Act
are unheard of.

Mental health programmes are rare and completely
dependent on donor funding. Sponsorship for training in mental health is
dwindling, and most postgraduate students in psychiatry have lately
been from other countries in the region.

The truth of the matter is that this continued neglect of mental health poses a grave danger to the well-being of our country. The
danger is not as abstract as saying that a nation whose mental health
is unattended to cannot prosper socially or economically.

It is
the real danger that mentally unwell people are running this country and
making decisions that affect all of us. Mentally unwell people are
teaching our children, preaching in our places of worship, driving our
public transport vehicles, and treating our sick relatives in hospitals.

Mentally
unwell people are shaping national discourse in the media, and others
are leaving their homes in droves to join Al Shabaab and related
militias. Mentally unwell people are roaming our streets unattended, posing unspoken dangers to themselves and others. Mental ill-health, running the entire gamut from mild afflictions to the more severe disorders, is very common in this country.

And
unless we start funding mental health programmes and paying attention
to staffing and infrastructure needs, we might as well give up on all
the other national endeavours we are pretending to pursue.

The
writer is the secretary, Kenya Psychiatric Association and a senior
lecturer at Moi University’s school of medicine lukoye@gmail.com;
twitter @LukoyeAtwoli